Ageing and Exercise for the Elderly

Key Points

• Aging results in several musculoskeletal changes causing a decline in physical functions. Abilities like strength, flexibility, and power are also compromised. Regular exercise is an effective intervention for reversing this age-related decline and provides a myriad of health benefits to the aging population.
• It is increasingly apparent that resistance training alone or in combination with aerobic training and Yoga is a cost-effective intervention for preventing sarcopenia and certain chronic diseases, improving several health factors and overall quality of life.

 

Introduction

India’s older population is expected to increase dramatically over the next four decades. Fortunately, there is growing evidence suggesting that old age need not necessarily be accompanied by physical decline and independence loss and that regular exercise can improve the quality of life and promote independence in the aging population.

As it is in the case of younger adults, regular exercise has also been shown to provide a multitude of benefits to the elderly. Regular exercise decreases all-cause mortality and morbidity in aging adults and also the inflammatory markers. 

Improvements in metabolic, cardiovascular, and physiological health are well documented and this holds good even for adults who were not active until late in life. Thus, it is never too late to reap the benefits of physical activity.

Resistance Exercise

In aging adults, due to sarcopenia, muscle strength and power reduce by 15% per decade after the age of 50 years and 30% per decade after age 70 years. This reduction of strength can lead to an enhanced risk of immobility and decreased life quality. Impaired mitochondrial function, associated with inactivity, may also be a contributing factor to the development of sarcopenia and insulin resistance.

Resistance exercise has the potential to improve strength and reduce frailty in older adults. Along with that, resistance training can also decrease the symptoms of numerous diseases and chronic conditions including arthritis, diabetes, osteoporosis, back pain, etc. 

Progressive resistance training improves aerobic capability, glucose tolerance, muscular strength, power, and muscle ‘quality’ (defined as the ability of the muscles to efficiently partition substrates for energy).

Training guidelines

1. Pre-participation screening- It is important at this age. The risk factors, health conditions, physical limitations, and initial fitness levels of the elderly individual should be carefully examined. Chronic health conditions should not stop individuals from strength training. It is likely, that he/she will still be able to participate in a resistance training program even if he/she has arthritis, osteoporosis, diabetes, congestive heart failure, or has recently suffered a heart attack, once the appropriate evaluation and treatment have been initiated.

1. Exercise selection- Initially sedentary older adults should start slowly and gradually progress their training volume and intensity. Begin with simple exercises such as wall push-ups, toe raises, repeatedly sitting and rising from a chair, etc. Once the basic form is comprehended and enough mobility is attained, training intensity needs to be progressively increased. This can be done by introducing a variety of exercises including external resistance and increasing weight to further drive strength gains. 7-8 exercises should be included targeting all the major muscle groups like quadriceps, hamstrings, gluteus, biceps, pectorals, deltoids, triceps, etc.

1. Training frequency- Training should be done on alternate days, beginning at 2-3 days per week.

1. Load, repetitions, and sets- Individuals should start at a relatively safer intensity of 40% ORM, performing 2-3 sets of 8-12 repetitions for each exercise. Intensity should increase as appropriate.

Other Types of Training

Along with resistance training, aerobic training has shown several benefits in the older population. 

Aerobic training promotes cardiorespiratory fitness, increases brain volume, and has the potential of remodeling myofibers and increasing muscle strength. It also improves the gait pace, and quality of life years (QALY) and is a cost-effective intervention. As in resistance training, sedentary individuals should begin aerobic exercises at a very low level and gradually progress the exercise intensity.

Concurrent training (combined aerobic and resistance training in the same session) is beneficial in the aging population. However, the exercise order in which aerobic and resistance exercises should perform is also critical for the efficacy of the training program. Performing resistance training before aerobic training has been shown to reduce arterial stiffness in the elderly, with no effect on muscle mass and strength.

In India and all over the world, yoga has recently gained a lot of interest as another mode of physical activity. A recent systematic review concluded that therapeutic yoga may assist in decreasing fall risks and improving the sleep quality in older adults.

Several other studies reported a positive association between yoga and other health markers such as total cholesterol, LDL, VLDL, pulse, respiratory rate, blood pressure, and blood glucose. This indicates that yoga can also be included as a part of training and conditioning programs for older adults.

Conclusion

Regular involvement in an exercise program is an effective strategy to maintain or improve the quality of life and physical health of older adults. Resistance training can improve strength and muscle mass, and reduce the signs and symptoms of many chronic diseases like osteoporosis, arthritis, diabetes, etc. 

Aerobic training is effective in promoting cardiovascular health and reducing arterial stiffness. Thus, these two training modes can also be combined to derive maximum benefits. Along with that, yoga has shown to be beneficial in improving physical and physiological health and improving certain health markers in the elderly.

Author:

Aditya Mahajan

Assessment Division,

Institute of Nutrition and Fitness Sciences (INFS)

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